On August 31, nurses in Wichita, Kansas, held a rally outside Ascension Via Christi St. Francis Hospital. This move comes after nurses from the hospital and two others—Ascension Via Christi St. Joseph Hospital (also in Wichita) and Ascension Seton Medical Center in Austin, Texas—delivered petitions to hospital management in July during an ongoing bargaining process. The petitions, according to a press release from the nurses’ union, demanded the hospitals “take urgent action to improve patient care.” The nurses are represented by National Nurses United (NNU), the largest union of registered nurses (RNs) in the United States.
These moves are part of a long process of union organizing efforts by Ascension nurses. Nurses at each of these three locations voted to form a union within the last year. Contract negotiations began in late 2022 but ultimately reached an impasse, leading to the largest nurse strike in Texas history on June 27. Over 2,000 participants joined the strike both in Austin and in Wichita.
Following the one-day strike, hospital management locked nurses out of the hospital for an additional three days, stating that they were contractually obligated to replace striking workers with “travel nurses” for four days before they would be allowed back to work. Nurses and the union saw this as retaliation. Negotiations and bargaining are continuing this month between the nurses and management.
Ascension is one of the largest private healthcare systems in the United States. They operate over 2,600 healthcare sites in nineteen states, including 139 hospitals. Ascension is currently the third largest healthcare system by net patient revenue, coming in at $23 billion. Since these three locations are represented by National Nurses United, they joined together in striking efforts. (There are other nurse unions at various other Ascension hospitals, but they have different representation). Although the two Kansas sites are less than five miles apart and have the same demands, Ascension has refused requests for joint bargaining, nurses say.
The nurses’ main concern is lowering the nurse-to-patient ratio.
Having a safe nurse-to-patient ratio—usually around one nurse per four or five patients—is critical for proper patient care. Nurses at Ascension facilities, in contrast, are often saddled with twice that number.
“Conditions, especially for floor nurses and med-surg [medical-surgical] nurses [are] pretty bad, just with lack of staffing, lack of supplies, lack of support from management,” Samantha Steele, an RN at Ascension Seton Medical Center, tells The Progressive. “And it trickles down to the patient. That’s what we’re here for. We’re here to care for the patient, and we want them to get the best care.”
According to the American Nurses Association, having a safe nurse-to-patient ratio—usually around one nurse per four or five patients—is critical for proper patient care. Nurses at Ascension facilities, in contrast, are often saddled with twice that number. “[At Ascension, med-surg] nurses always have usually six or seven and sometimes eight or nine [patients],” Marvin Ruckle, an RN at Ascension Via St. Joseph Hospital, says. “When you’ve got more than what should be a reasonable assignment . . . it just sets the nurse up for making a mistake. And it’s not their fault. It’s just being human. And we can only do so many tasks at one time.”
Short-staffing in hospitals has been an issue for healthcare workers for years, but it was made worse by the COVID-19 pandemic. A report by the National Council of State Boards of Nursing (NCSBN) found that about 100,000 nurses left the workforce during the pandemic due to stress, burnout, or retirement. The report’s findings indicate that if working conditions do not improve by 2027, almost 900,000 nurses, a fifth of the total number of currently registered nurses, intend to leave the workforce.
Hospitals across the country lost many of their nurses due to “moral injury,” a term that describes the overwhelming fear, anxiety, guilt, and anger that frontline workers feel when put into life or death situations without the support or resources needed to properly care for themselves and their patients. What’s left is an influx of travel nurses, a solution which is both expensive and temporary, and a slew of overworked and overwhelmed resident nurses who do not trust their management and administrators, says Ruckle.
Travel nurses are RNs with clinical backgrounds that work in “high-need” areas, including hospitals with nurses who are striking. As of 2022, pay for travel nurses averages around $150 an hour, more than three times the national average hourly wage for a full-time RN. Although these travel nurses are much more expensive, they give hospitals the temporary personnel they need to function without having to change the conditions for full-time nurses.
But temporary nurses are not a solution to inadequate patient care. Nurses that do not work at a hospital full time will likely not be as familiar with the hospital layout, training, protocols, or patients in the way that a full-time RN is.
Despite the short staffing at hospitals, there is no shortage of RNs. According to the National Council of State Boards of Nursing, there are just under 1,000,000 RNs with active licenses who are not practicing. Due to poor working conditions and “moral injury,” nurses are opting for roles at settings outside of the hospital, such as outpatient care clinics and doctor’s offices.
“It’s so difficult, the understaffing and not being able to provide the care that you want to provide the patients,” says Steele. “That’s a lot of the moral injuries. You just want to provide quality care, but you’re only one person, you can only do so much.”
This problem is not limited to Ascension hospitals. In New York State, nurses in the Bronx and Manhattan organized a strike in January to demand better staffing. More than 7,000 nurses marched in the streets of New York City to advocate improved staffing and better care for their patients.
Mount Sinai, one of the hospitals where workers walked out, assured the public that they are working to address these shortages, citing the hiring of 4,000 new nurses in the past three years, and that the staff today consists of 503 more nurses than the staff in 2019. Minnesota, California, and Hawaii also saw recent strikes by healthcare professionals.
On August 22, nurses at Ascension St. Joseph-Joliet in Illinois went on strike for two days. Similarly to the strikes in Wichita and Austin, the nurses needed to wait an additional two days to return to work so that Ascension could provide the travel nurses that replaced them the contractually required four days of work. The nurses in Joliet, represented by Illinois Nurses Association, also cited understaffing as a major issue during their negotiations, which resumed on September 8.
Ascension nurses in Michigan recently striked against the healthcare company on September 11. These nurses, represented by the Office and Professional Employees International Union Local 40, have been at the bargaining table since 2022, and have cited concerns about the lack of progress in negotiations.
Ascension’s reaction to the strikes gives little hope or assurance to the nurses that are currently struggling with the administration.
According to an analysis of the Current Population Survey, as of 2022, only 17.9 percent of RNs reported being covered by a union and 15.9 percent reported being union members. Although trends for reported unionization for health care workers have remained steady for the past decade, nurses' actions across the country show that these upcoming years are more crucial than ever.
“We just feel that our employer does not care about nurses or the patients,” says Steele. “It's just an overall feeling that they just care about making profits and making money.”
Ascension’s size and revenue would suggest that it does have the means to improve conditions. As a Catholic nonprofit, Ascension is exempt from about $1 billion a year in taxes. In 2022, The New York Times reported that Ascension had $41 billion in an investment arm and another $18 billion in cash reserves. Meanwhile, in Michigan in the past several years, the nonprofit has reduced staffing to maintain profitability and opposed legislation that would ensure minimum nurse-to-patient ratios.
The message from these nurses is clear: An overworked nurse can’t provide the care and attention that their patients need.
The nurses in these hospitals are not just striking for improved staffing, but for better care for their patients, says Ruckle. As bargaining efforts continue, nurses are hopeful of reaching an agreement that ensures their own rights and the rights their patients have to the best care possible. The message from these nurses is clear: An overworked nurse can’t provide the care and attention that their patients need. Without a management dedicated to the rights of its workers and staff, the consequence falls on the patients who need care and whose presence keeps the hospital in business.
“This is much bigger than me or any of us nurses that want better for our community,” says Ruckle. “This is about making health care better for communities, better for families, better for the citizens who will want to be a part of this community.”